Form RADJR-2012-03 NON-IMMIGRANT VISA This document is NOT FOR SALE Republic of the Philippines Department of Justice BUREAU OF IMMIGRATION Manila GENERAL INSTRUCTION To avoid summary dismissal/delay in the processing of your application/petition, please be advised of the following: 1. This Consolidated General Application Form (CGAF) is written in the English language. Enter legibly all the information required into the appropriate spaces on the form. If information required is not applicable with your application, please write “N/A” therein. Do not leave any item blank. The Bureau will not act on application forms that are accomplished incorrectly. All entries must be in CAPITAL LETTERS. Your answers must be in English and must use English characters only. Letters like ñ, é, ü, and ç are not recognized by the system. For instance, please enter names like “Muñoz” and “Sémonin” as “Munoz” and “Semonin”, respectively. 2. All sworn statements or affidavits must be duly notarized. 3. Documents executed outside the Philippines must be authenticated by the Philippine Embassy/Consular Officials of the Philippine foreign service at the place of issuance or nearest to it, with English translation, if written in other foreign language. 4. The CGAF must be accomplished in duplicate [two (2) copies]. 5. Required documents for visa application shall be attached on the right-hand side portion of the applicant’s folder while required documents for ACR I-Card application on the left-hand side portion. 6. All documents required for submission must be arranged in the order as listed hereunder, otherwise your application or petition cannot be processed immediately. 7. The original valid Passport of applicant must be submitted to the frontline officer of the Central Receiving Unit for scanning. Thereafter it shall be returned. - more at the back ____________________________________________________________________________________ CHECKLIST OF DOCUMENTARY REQUIREMENTS FOR APPLICATION FOR CONVERSION TO STUDENT VISA (Section 9, Paragraph F) 1. [ ] Request Letter from the applicant, with a statement that all documents submitted were legally obtained from the corresponding government agencies; 2. [ ] Consolidated General Application Form duly accomplished and notarized (BI Form No. RADJR-2012-03) 3. [ ] Original copy of the Notice of Acceptance containing a clear impression of the school’s official dry seal and duly notarized written Endorsement from the school for the conversion of the applicant’s status signed by the School Registrar; 4. [ ] Original copy of Medical Certificate issued by the Bureau of Quarantine and International Health Surveillance or a government medical institution with competence to certify that the applicant is not afflicted with any dangerous, contagious or loathsome disease and is mentally fit; 5. [ ] Photocopy of applicant’s Passport (biodata page, admission and authorized stay); 6. [ ] Original copy of National Intelligence Coordinating Agency (NICA) Clearance; and 7. [ ] Original copy of Bureau of Immigration Clearance Certificate. CERTIFICATION This is to certify that the documents submitted in support of the application/ petition for _______________________________________ filed by __________________________________ are complete in accordance with the above checklist. Central Receiving Unit Evaluator: _______________________ Signature over Printed Name _________________ Date FORM: RADJR-2012-03 This document is NOT FOR SALE INSTRUCTIONS TO PROPERLY ACCOMPLISH THE CONSOLIDATED GENERAL APPLICATION FORM (CGAF) (BI FORM RADJR-2012-03) I. APPLICATION INFORMATION 3. Contact Number – Write your contact number in the Philippines, either landline phone or mobile phone. A. Nature of Application 1. Conversion - Check the box beside “Conversion” if your application is for a change of visa other than your existing visa. For example, from Temporary Visitor’s Visa (TVV) to Missionary Worker Visa. 2. Extension - Check the box beside “Extension” if your application is for the change of the probationary status of your immigrant visa to permanent status. 3. Permit - Check the box beside “Permit” if your application is for the issuance of a Special Working Permit (SWP). 4. Inclusion - check the box behind inclusion if your application is for inclusion of your dependent in your visa. B. Type of Visa Application 1. Non-Immigrant Visa/Permit Applied For - Write the specific type of non-immigrant visa or permit you are applying for conversion, extension or issuance, as the case may be. 2. Present Immigration Status – Write the type of your current valid visa. 3. Last Day of Authorized Stay – Write the expiration date or last day of authorized stay of your current valid visa in month, day, year (MM-DDYYYY) format. L. Character Reference in the Philippines – Write the full name of one (1) person in the Philippines who knows you personally and can attest to your character, with his/her complete address and contact number. C. Photograph – Attached your 2” x 2” colored photograph with white background using permanent glue in the photograph box. The photograph must be taken within the last six (6) months to reflect your current appearance. Scanned photographs are not allowed. IV. SCHOOL’S INFORMATION D. Method of Application 1. Personal – Check the box beside “Personal” if you are personally filing your application. 2. Authorized Representative – Check the box beside “Authorized Representative” if you are filing your application through a BI-accredited travel agency or law firm. If you are filing your application personally, write “N/A” in the spaces in this portion. a. Accreditation Number – Write the accreditation number assigned by the BI to the accredited travel agency or law firm. b. Name of Authorized Representative – Write the name of the BI-accredited liaison officer or employee of the travel agency or law firm that shall transact with the BI for and in your behalf. II. APPLICANT’S PERSONAL INFORMATION A. Name of Applicant 1. Last Name/Surname – Write your last name or surname as written in your current valid passport. 2. First Name/Given Name – Write your first name or given name as written in your current valid passport. 3. Middle Name – Write your middle name, if any, as written in your current valid passport. If you do not have a middle name, please write “N/A” in the space provided. 4. Other Names/Aliases – Write your other names, alias or aliases, if any, that you use or indicated in your other documents submitted in support of your application. B. Date of Birth – Write your date of birth in month, day, year (MM-DDYYYY) format. C. Country of Birth – Write the country where you were born as indicated in your current valid passport. D. Citizenship/Nationality – Write the country where you are currently a citizen or national. E. Gender – Check the appropriate box, either “Male” or “Female”. F. Height – Write your present height in centimeters (1 foot = 30.48 centimeters). G. Weight – Write your present weight in kilograms (1 pound = 0.4535 kilograms). H. Civil Status – Check the appropriate box beside your present applicable civil status. I. Spouse/Wife/Husband – Write the Family Name/Surname, First Name/Given Name and Middle Name of your wife or husband, as the case may be. If you do not have, write “N/A” in the space provided. J. Name of Children and Dates of Birth – Write the full name of your children and their dates of birth in month, day, year (MM-DD-YYYY) format. You may use additional sheets of paper if necessary. If you do not have any, write “N/A” in the spaces provided. K. Complete Address 1. Philippine Address – Write your complete address in the Philippines, indicating the house/building number, street, subdivision, barangay, city or municipality, province and zip code. 2. Foreign Address – Write your complete address in your country of residence abroad or nationality, indicating the house/building number, street, subdivision, barangay, city or municipality, province and zip code. III. APPLICANT’S TRAVEL INFORMATION A. Passport Number – Write the passport number as written in the bio-page of your current valid passport. B. Place of Issue – Write the city and country where your current valid passport was issued. C. Expiry Date/Valid Until – Write the expiration or “valid until” date indicated in the bio-page or amendment page in your current valid passport in month, day, year (MM-DD-YYYY) format. D. Date of Last Arrival – Write the date of your latest arrival into the Philippines as stamped in your passport in month, day, year (MM-DDYYYY) format. E. Flight Number – Write the accurate flight number of your latest arrival into the Philippines as stamped in your passport. A. Name of School – Write the complete name of the school, college, university or educational institution you are going to enroll in. B. Registered Address of School – Write your complete address in the Philippines of your school, university or educational institution, indicating the house/ building number, street, subdivision, barangay, city or municipality, province, zip code and contact number. C. Name of Petitioner’s Representative – Write the name of the school’s accredited representative with the BI in relation to your application. D. Course/Degree – Write the course, degree or academic program you are going to take up. E. School Year – Write the school year, semester or trimester of the duration of your enrollment with the school V. GUARDIAN A. Guardian’s Name - Write the Family Name/Surname, First Name/Given Name and Middle Name of your guardian in the Philippines while you are studying. B. Relationship – Write your relationship with your guardian. C. Address - Write your complete address in the Philippines of your guardian, indicating the house/building number, street, subdivision, barangay, city or municipality, province, zip code and contract number. VI. ACR I- CARD A. ACR Number – Write your ACR Number as written in your current valid I-Card, if you have been already issued an ACR I-Card. If not, write “N/A” in the space provided. B. Issued Date – Write the date when your current valid I-Card was issued in month, day, year (MM-DD-YYYY) format. C. Valid Until – Write the date until when your current I-Card is valid in month, day, year (MM-DD-YYYY) format. D. Certificate of Residence Number – Write your CRN as written in your current valid I-Card, if you have been already issued an ACR I-Card. If not, write “N/A” in the space provided. E. Are you planning to leave the country within 30 days upon issuance of your ACR I-Card? – Check the box beside “YES” if your answer is in the affirmative, other check the box beside “NO”. VII. CERTIFICATION A. Contents of the Certification – You must first carefully read and understand the statements stated in the Certification. In addition to the summary denial of your application, you can be criminally prosecuted if it is established that you knowingly made any false statement or representation under oath in your CGAF, and upon conviction thereof, you shall be fined or imprisoned, or both, as well as be subject to deportation, upon completion of service of sentence, if you are a foreigner. B. Signature and Date – You and your petitioner, if applicable, shall affix your respective customary signatures in the space provided and write the date when you accomplished and signed the CGAF. C. Notarial Requirement – Your CGAF must be subscribed or sworn to under oath before a Notary Public or an officer duly authorized to administer oath. CHECKLIST OF REQUIRED DOCUMENTS FOR ACR I-CARD APPLICATION (NEW) 1. [ ] 2ND copy of the Consolidated General Application Form; 2. [ ] Photocopy of Board of Commissioners’ Order (to be attached by the Executive Office upon visa implementation); 3. Photocopy of Passport - [ ] Biodata page - [ ] Visa page with latest arrival stamp - [ ] Visa implementation page (to be attached by the Executive Office upon visa implementation) 4. [ ] Photocopy of Official Receipt showing payment of the applicable fees.